Early Encounters with Burnout

I first remember hearing the term ‘burnout’ as an undergraduate 3rd year nursing student while doing a literature review for an essay with the very funky title of ‘Who cares for the carers?’ This topic intrigued me as I vividly recall submitting a tome on the subject. I argued that the chief protagonist for the epidemic of nurses choosing to leave the profession must be the emotional burden of nursing. I am sure I was pretty earnest in my condemnation of burnout. I am undoubtedly incensed that nurses were ditching the profession after investing so much time and effort into qualifying. I doubt I paid any attention to burnout's impact on nurse turnover or its long-term implications. This did not seem important at the time: Ahh, the innocence of youth.

Ongoing Struggles with Retention

Over the last thirty years of my nursing career, the term 'burnout' has gradually been replaced by the more user-friendly term 'compassion fatigue' (Barron, 2024). Since that initial essay, I have adopted a slightly more sophisticated understanding of why nurses leave the profession, including the severe consequences for the quality of care when experienced professionals walk away. The picture is bleak; the escalating crisis of nurse turnover haunts and taunts almost all Australian health, disability, and aged care services. We are not alone. As I write this article from London, the ITV news is humming in the background and reporting that almost half of the United Kingdom nursing workforce is actively considering quitting the profession (Barry, 2024). This issue is worldwide, and the WHO has been warning about the ticking timebomb of health, aged, and disability workforce gaps for many years (World Health Organisation, 2022).

Care - The Real Cause of Fatigue?

However, despite all the overwhelming evidence, I am dismayed with the number of organisations that believe nursing attrition can be slowed by offering subsidised pilates classes or lunchtime massages (Church, 2023). I also refuse to subscribe to the convenient, victim-blaming mentality that pigeonholes this complex issue as an unavoidable consequence of complicated patient interactions (Barron, 2024). As a registered nurse specialising in strategic health and aged care education, I have barely touched a patient in the last twenty years. However, I, too, have experienced my share of work-related emotional and physical compassion fatigue symptoms. An occasional free sausage sizzle has not alleviated my symptoms, so hope is fading. Like all good nurses, I have self-diagnosed and decided that my ‘issue’ is that I just care about my profession too much. My fatigue has nothing to do with patients and everything to do with the cumulative exhaustion built up over many years of arguing, cajoling, or even begging for nursing professional development to be raised beyond box-ticking mandatory training (Sharples, 2024).

The Unseen Value of Skilled Workers

I, too, may have chosen to quit had Emma, my favourite barista, not left my local café. Without a backward glance, she bailed and took all the years of stored-up knowledge of how the regulars liked their coffee. So, there we were, announcing our skinny oat, double shot, extra hot, flat whites to the replacement barista as the queue got longer and nerves visibly frazzled. It had not occurred to the proprietor that we chose his café not because of him but because of Emma. I’m sure he realised too late that he had not just lost a staff member, he lost the key person who had the knowledge and skill to maintain the quality and be efficient at the same time. Standing there, I had an epiphany.

Rethinking the Metrics that Matter

I needed to stop believing I could persuade senior executives to invest in nursing professional development using the exact rehashed phrases regarding the relationship between nurse education and quality care. Not because I do not believe that nurse education decreases hospital mortality (Aiken et al., 2014), increases effective care (King et al., 2021), and safe patient services (Todd et al., 2024); of course, it does. However, if an organisation is struggling to recruit and retain a sustainable nursing workforce, putting pressure on them to invest in professional development by quoting statistics about quality care may not be metrics that matter when facing dire consequences to their bottom line. More than ever, our organisations are struggling with the complex business of delivering sustainable health, aged and disability care services.

After failing to attract and retain staff, an aged care provider ceased operations last year (Cockburn, 2023). It cared very much about the quality of care, but this didn’t save it when it could not maintain a viable workforce.

Cost-saving or Budget-draining?

As educators, we have an unprecedented opportunity to support our organisations by leading the solution to the growing crisis in recruitment and retention (World Health Organisation, 2022). We need to stop asking organisations to invest in professional development and instead use robust qualitative and quantitative measures of engagement and sustainability as evidence that professional development saves money. Education always lands last in line when deciding the budget and becomes the first area cut when times get tough (Opperman et al., 2018). I predict that this will not change. However, you can provide an evidence-based business case demonstrating education as a significant workforce cost-saving rather than budget-draining. In that case, I am also willing to bet that your argument for professional development might gain some traction.

Defining Engagement and Sustainability Metrics

To achieve this, you must first identify the measures of workforce engagement and sustainability that matter to your organisation. Let us take the recruitment and retention of newly qualified registered nurses as an example. You can start to be more specific regarding what your organisation would consider successful in the engagement and sustainability of new grads (Marks-Maran, 2015). If recruiting newly qualified registered nurses has been difficult for your organisation, it will cost them money. Consider the time and resources invested in recruitment campaigns, open days, advertising, shortlisting, interviewing, developing contracts, onboarding, and orientation. Consider how this could easily be measured by reviewing human resource records and the staffing hours dedicated to recruitment. These are the metrics of engagement, and they matter because all of these elements cost significant amounts of money.

Linking Retention and Wellbeing

Now consider the retention of newly qualified registered nurses in your organisation. How many new grads remain within the organisation after one year, and how many transfer to St Elsewhere, leaving gaps in your workforce that you must plug with overtime, agency staff or contingency labour costs? How tired are your nursing teams? How do they rate their job satisfaction, work/life balance, interest in growing and developing with the organisation, and compassion fatigue? Are your experienced staff, the ones who, like Emma, hold vast amounts of organisational knowledge, so overwhelmed they are ready to quit? All of these elements are potential sustainability metrics, and they also matter. As a learning and development professional, you don’t have to continue falling into a well of frustration if your organisation seems blinkered to the need to actively commit time and resources to slow nursing workforce attrition (Shanafelt & Noseworthy, 2017). The good news is that you are ideally placed to provide proactive cost-saving solutions simply by accessing the evaluative measures of engagement and sustainability that will be important to your organisation.

Calculating the True Cost of Turnover

When I first wrote that original essay on burnout in the early 1990s, estimations placed the cost to a hospital at $16,000 AUD every time a registered nurse resigned; this amount represented the average cost of recruiting a replacement nurse to fill a vacancy (Jones, 1992). Suppose this article has made you consider the current costs of nurse turnover to your organisation. In that case, you may be interested in some online calculators that can assist with this. Using a cost-of-turnover calculator can be a powerful way to measure the cost of attrition within your workforce (Drake International, 2024). Demonstrating the monetary value of improving the sustainability of your nursing workforce by even 30 per cent may be a metric that matters for an executive team struggling to find and keep staff. If we stop asking our staff if they liked the show and instead focus on developing evaluative measures of engagement and sustainability to demonstrate that investing in the professional development of our health, aged, and disability workforce can reduce the cost of turnover (Marks-Maran, 2015), we may just find that learning and development becomes an essential rather than expendable element of our workplaces.

Leveraging YOU as a Retention Tool

The secret weapon we all have in our education toolkit is the ability to create professional development opportunities that draw employees into an organisation and, more importantly, the career development incentives that can encourage them to stay. In the third and final article in this series, ‘Metrics that Matter,’ we will consider the types of professional development programs that can add real value to our organisations and the options available to us to measure the impact of education on maintaining the quality of nursing care.

References

Aiken, L. et al., 2014. A retrospective observational study of Nurse staffing, education, and hospital mortality in nine European countries. Lancet, 383(9931), pp. 1824-1830. Link to Article

Barron, B., 2024. Burned Out on Burnout? Strategies to Combat Compassion Fatigue in Nursing. The Oklahoma Nurse, pp. 10–11. Available at: Link to Article

Barry, R., 2024. A survey shows that almost half of nurses in England plan to quit or are considering it. [Online] Available at: Link to Article [Accessed 16 May 2024].

Church, E., 2023. Experts call for end to ‘victim blaming’ approach to nurse burnout. [Online] Available at: Link to Article [Accessed 30 April 2024].

Cockburn, P., 2023. ABC News. [Online] Available at: Link to Article [Accessed 2 May 2024].

Drake International, 2024. The cost of employee turnover calculator. [Online] Available at: Link to Article [Accessed 23 May 2024].

Jones, C., 1992. Calculating and Updating Nursing Turnover Costs. Nursing Economics, 10(1), pp. 39–45. Available at: Link to Article

King, R. et al., 2021. Factors that optimise the impact of continuing professional development in nursing: A rapid evidence review. Nurse Education Today, Volume 98, p. 104652. Link to Article

Marks-Maran, D., 2015. Educational research methods for researching innovations in teaching, learning and assessment: The nursing lecturer as a researcher. Nurse Education in Practice, Volume 15, pp. 472-479. Link to Article

Opperman, C., Liebig, D., Bowling, J., et al., 2018. Measuring Return on Investment for Professional Development Activities: 2018 Updates. Journal for Nurses in Professional Development, 34, pp. 303-312. Link to Article

Shanafelt, T. & Noseworthy, J., 2017. Executive leadership and physician well-being: Nine organisational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), pp. 129–146.Available at: Link to Article

Sharples, K., 2024. The Challenge of Mandatory Training for Compliance Driven Organisations. [Online] Available at: Link to Article [Accessed 30 April 2024].

Todd, D., Deal, J. & Parker, C., 2024. Virginia Henderson Institute of Clinical Excellence Nurse Leader Academy: An Innovative Approach to Nurse Leadership Development. Nurse Leader, 22(1), pp. 66–72. Link to Article

World Health Organisation, 2022. Ticking timebomb: Without immediate action, the European Region's health and care workforce gaps could spell disaster. [Online] Available at: Link to Article [Accessed 22 May 2024].

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